Analysis risk factors of long-term adverse outcomes and a prediction nomogram for coronary artery disease patients underwent fractional flow reserve

TL;DR

This study identifies risk factors and builds a tool to predict long-term complications in patients with coronary artery disease who undergo FFR testing.

Contribution

A new nomogram is developed to predict long-term adverse outcomes in FFR-treated patients.

Findings

Age, diabetes, and hyperuricemia were key predictors of adverse outcomes.

The nomogram showed strong predictive performance with AUC values up to 0.924.

Calibration and decision curve analysis confirmed the tool's clinical utility.

Abstract

Background: The role of fractional flow reserve (FFR) in intermediate lesions has been widely used and recommended by guidelines. However, the long-term outcomes in patient with an intermediate stenosis received FFR have not yet been investigated comprehensively.

Methods: We retrospectively included 558 patients underwent both coronary artery angiography (CAG) and FFR. Multivariate logistic regression analysis was employed to identify the independent predictors of major adverse cardiovascular and cerebrovascular events (MACCEs). Additionally, we constructed a prediction nomogram and tested its performance by multiple methods.

Results: During a median follow-up of 6.2 years, 87 (15.59%) adverse events were documented. Multivariate logistic regression results revealed that age (OR 1.13, p<0.01), diabetes mellitus (OR, 5.87, p<0.01), hyperuricemia (OR, 2.91, p<0.01) were independently associated with MACCEs. The nomogram consists of age, smoking, hypertension, diabetes mellitus (DM), hyperuricemia, and FFR≤0.8 six factors. The AUC of 3-year, 5-year, 7-year receiver operating characteristic (ROC) curves of training set were 0.697, 0.823, 0.854, and of validation set were 0.845, 0.924, 0.856. The calibration curves and decision curve analysis (DCA) illustrated the ability of the nomogram to predict long-term adverse outcomes and its net benefits in clinical practice.

Conclusions: Age, DM, and hyperuricemia were independently associated with long-term adverse outcomes, and the constructed nomogram may be used as a visible tool to predict long-term adverse outcomes for patients underwent FFR.

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